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QUAD

Abductovarus Forefoot

The E QUAD foot-Type is one of the most unique looking feet, often with a reverse-lasted foot shape. This foot-type is the result of a combined Uncompensated Rearfoot Varus, coupled with a large Rigid Forefoot Varus.

The E QUAD foot-type is one of the most destructive foot-types of all. The combined uncompensated rearfoot and forefoot varus deformities in this foot-type create a very rigid foot that is unable to provide the motions necessary to load the medial aspect of the foot during stance phase of gait. It is for this reason that, when an individual with this foot-type is standing still, they will tend to stand on the outer borders of their feet with the inner side of the foot elevated from the ground. These people hate to stand still because the only way to ever really load the inner side of the foot is to get the heel off the ground! Once in propulsion, the medial heel pivot will allow the medial column of the foot to eventually load. But all this compensation gets tiring after a while, and causes repetitive torque about the midtarsal joint! Even as a youth, and certainly by the time this person is in their teens, they are already showing signs of midtarsal joint breakdown and the acquisition of a reverse last foot shape.The key note feature of this foot-type is by far the ballistic heel whip that is evident at heel rise. The larger the forefoot varus deformity the bigger the heel whip, the larger the toe sign, and the greater the chance of kicking themselves in the opposite leg.

All Quadrastep Orthotics are available in Regular and Narrow Widths, and with a topcover an an additional charge. For more information seeCustomized Orthotics.

Propulsion Phase
As the heel lifts off the ground, the 1st metatarsal head should be fully loaded. If the forefoot varus is too large and the medial column has not loaded successfully, the heel may "whip" medially as the foot pivots around the 5th metatarsal head in order to complete loading of the 1st metatarsal head. This medial heel whip creates heavy shearing over the 5th metatarsal head, leading to heavy callus formation. The medial heel whip also results in a narrow heel base gait. Runners with this foot type often complain of "kicking themselves" when they run. After the pivot, the foot "plops" down heavily onto the medial column, often over-powering the 1st metatarsal. The 1st metatarsal may be driven up dorsally by the floor reaction, resulting in excessive pressure on the 2nd metatarsal head, again resulting in callus formation. Final propulsion is off the medial edge of the hallux, resulting in a pinch callus.

Midstance Phase
As weight moves forward over the foot, the arch and midtarsal joint remain fairly rigid, with excessive pressure borne along the lateral column and the head of the 5th metatarsal. At this point, the body still needs to complete loading of the 1st metatarsal because of the underlying rigid forefoot varus deformity. Since the arch can not adequately lower vertically because of the inverted rearfoot, it will start to bend horizontally on the medial side of foot. This medial/horizontal breakdown of the oblique midtarsal joint is referred to as "shelfing." It may also present as the ankle bending inward toward midline. This shelfing coincides with forefoot abduction (positive toe-sign) with the development of "creasing" on the lateral side of the foot. This combination will cause the foot to acquire a "reverse lasted" foot shape. Look at the left foot in the above picture and completely ignore the right foot. Looking at the outside edge of the foot, you will notice a sharp angle as the forefoot bends out laterally. It almost looks like the arch is on the outside of the foot!

Contact PhaseAt initial contact, the calcaneus strikes the ground in an excessively inverted alignment relative to the ground. Since the deformity is largely uncompensated, very little rearfoot pronation is observed as the forefoot is lowering itself to the ground to conclude the contact period of gait. The head of the 5th metatarsal may be subjected to excessive pressure because of the rigid forefoot varus alignment and the prevalence of plantarflexed 5th ray deformities in this foot type. The primary compensation for this foot type in order, to lower the medial column to the ground, is external hip rotation, resulting in a large toe-out gait.